INS and endothelial dysfunction: Imbalance between insulin vascular actions via the phosphatidylinositol 3-Kinase (PI3K) and the mitogen activated protein kinase (MAPK) signaling pathways in insulin resistant states results in impaired endothelial vasodilator PI3K/eNOS/NO and augmented vasoconstrictor MAPK/endothelin 1 (ET1) pathways leading to endothelial dysfunction and exacerbated vasoconstriction (Kim et al., 2006; Prieto et al., 2013).